Covid shots mandated for health & education staff – Expert Reaction 

All front-line staff who work in schools, early childhood education, and health & disability services, will soon be required to be vaccinated against Covid-19. 

Health workers must have both Covid shots by 1 Dec, while education workers – including administrators, maintenance staff and contractors – must be fully vaccinated by the start of January. Alert levels will remain the same: for at least another week in Auckland, and midnight Thursday for Waikato and Northland.

The SMC asked experts to comment on the news.

Dr Amanda Kvalsvig, Epidemiologist and Senior Research Fellow, Department of Public Health, University of Otago, Wellington, comments:

“It’s a relief to hear the decision not to introduce any further loosening of restrictions at the moment. and to respond proportionately to the level of risk in Northland. These decisions will help to prevent cases and will support the extremely hard work of the contact tracing workforce. The decision to delay opening schools is very welcome, allowing the education system time to plan and prepare, and the vaccination measures are encouraging too. Taken together, the measures announced yesterday do seem to reaffirm the Government’s commitment to controlling Covid-19 while strengthening the vaccine rollout, and that clarification is very welcome.

“In her remarks, the Prime Minister indicated the importance of maintaining public support and adherence to Covid-19 control measures, including lockdowns. It would be good to hear more on that topic in the national conversation. In particular we need to hear from those experiencing the highest risk and impact from Covid-19, including a diverse spread of Aucklanders, Māori, Pasifika, people with underlying conditions, people who are marginalised, and children and their advocates. For the major policy decisions in the coming weeks it will be essential not to make assumptions on behalf of these groups about what they want to happen – and to hear their solutions about ways to reduce the hardships they’re experiencing.

“Sometimes the only option is to avoid a pandemic control measure that’s causing hardship – but a far better approach would be to have effective outbreak control delivered together with strong wellbeing support. That support might come in the form of benefits and payments, funding for workforces, Pātaka Kai (local food-sharing initiative), and many other resources. It would be good to see substantial social support going to the regions experiencing outbreaks at the moment. The success of the response may depend on it.”

No conflict of interest.

Dr Rawiri McKree Jansen (Ngāti Raukawa, Ngāti Hinerangi), Clinical Director, National Hauora Coalition, comments:

“All staff working in frontline roles (patient or consumer or customer facing roles) should be vaccinated. This is necessary to prevent them from being in harm’s way, and it is necessary to protect the patient/customer/consumer.

“There are additional public health measures that should also be mandated, and we need to elevate the focus from vaccine mandate to a public health suite of mandates. This includes scanning (or recording attendance), safe distancing, ventilation, masks, hygiene, and to stay at home if unwell.”

No conflict of interest. 

Professor Nick Wilson, Department of Public Health, University of Otago, comments:

“The Government has wisely kept the current Alert Level settings for Auckland, Waikato and Northland. But hopefully the latter two regions can soon move down to Alert Level 2 if there is no evidence of uncontrolled community spread in the coming days (based on community testing and wastewater testing).

“It was disappointing, however, that the Government did not clarify its strategic direction concerning Auckland and the rest of the country (as we have attempted to in a blog which discusses both “regional suppression” and “regional elimination”). It was also of concern that there was no announcement about strengthening internal borders around Auckland to prevent spread to other regions. For places like the South Island, we probably should be aiming to have some border controls so as to replicate the success of Tasmania, which has had no community cases for over 500 days.”

“The vaccine mandates were a very welcome move by the Government and these are well-targeted towards health and education workers who work with vulnerable populations. This is entirely justifiable from a duty-of-care perspective and is an increasingly common approach in other high-income countries, including Australia. For those health and education workers who refuse to be vaccinated against Covid-19, there will often be alternative work roles available where they do not interact with the public.”

“The decision not to open schools in Auckland will give more time for the introduction of safeguards. This approach fits with the views of a group of NZ paediatricians and public health doctors concerned with child health in a publication just out today.”

No conflict of interest.

Dr Nitasha Rimar, endocrinologist and physician, Northland, comments:

“As we continue to navigate the COVID-19 outbreak, it will be important to keep our unvaccinated kids safe, since they are susceptible to the potential long-term impacts of infection with SARS-CoV-2.* 

“We can devise a safer environment for our kids to return to school – one that involves utilising masks by teachers, vaccinating all eligible individuals around our children, early planning now on how to improve ventilation systems in schools, and begin making our children comfortable with wearing masks to protect themselves, their extended families, and their unvaccinated peers. Whether one is a proponent of mask use or not, it’s indisputable that such use will protect our vulnerable children and prevent them from contributing significantly to viral spread amongst the general population.

“Planning now to begin the Medsafe evaluation process for the Pfizer vaccine for our children aged 5-11 will also be imperative as it is currently being evaluated for emergency use authorisation by the FDA.”

No conflict of interest declared. 

Professor Michael Plank, Te Pūnaha Matatini and University of Canterbury, comments:

“The government had little option other than to keep Auckland at the current level 3 restrictions. It’s clear cases are trending upwards and it looks as though the shift from level 4 to level 3 has contributed to pushing the R number (the average number of people an infected person passes virus on to) above 1. Moving to step 2 of the reopening roadmap at this stage could easily cause cases to spiral out of control. At current vaccination rates, this could lead to large numbers of people need to go to hospital.

“As more people are fully vaccinated, this will help bring the R number down as well as reducing the risk of hospitalisation. This will eventually allow easing of restrictions and the faster people get vaccinated, the sooner we’ll be in a position to do this. In the meantime, we are still vulnerable and need to remain cautious. We also need to keep the option of a strict circuit-breaker lockdown on the table if cases do start to rise more steeply.

“We are now in a race between the virus and the vaccine. We need to do everything we can to slow the virus down and speed the vaccination programme up. This includes measures to slow inter-regional spread of the outbreak. Rapid testing and vaccination requirements for people crossing the Auckland boundary or travelling between North and South islands would help delay the spread of the outbreak into other regions. This won’t work forever but it could buy valuable time to vaccinate more people, especially in regions where vaccinations rates are currently low.”

Conflict of interest statement: I am partly funded by MBIE for research on mathematical modelling of COVID-19.

Dr Dianne Sika-Paotonu, Immunologist, Associate Dean (Pacific), Head of University of Otago Wellington Pacific Office, and Senior Lecturer, Pathology & Molecular Medicine, University of Otago Wellington, is available to comment.

“The best way to protect our children who currently don’t yet have access to a vaccine approved for them, is for everyone around them to get vaccinated.

“Infection patterns indicate that children and young people are more susceptible to the Delta variant of the Covid virus when compared with the original strain. Although more likely to have mild or asymptomatic disease, children can still catch the virus and become sick, they can still end up with long COVID-19, and for children and youth with underlying medical conditions, they are at higher risk of serious illness and hospitalisation.

“Of those affected by the current Delta outbreak, 17.1% were children aged 9 years and under – and included babies. The 12-15 year old age group is the most recent cohort to be added to the vaccination programme and will have had less time to get protected. If the Pfizer–BioNTech COVID-19 vaccine is also approved by MEDSAFE for use in children aged 5-11 years, this age group will also need to be supported to get vaccinated.

“In the meantime, we have an obligation to protect those who cannot protect themselves right now, and this includes our children, who still don’t yet have access to a vaccine that will keep them safe from COVID-19. Getting vaccinated demonstrates our commitment to keeping others safe – including our children. It is acknowledged that there will be legal ramifications that will need to be worked through to manage the new mandates in the health and education sectors announced by the government today.

“The ongoing potential impact and consequences for our most vulnerable communities at this time remains serious, with Delta continuing to spread out of Auckland at a time when restrictions were already being eased in Auckland, and vaccination rates needed to be higher to keep everyone protected.
“The recent COVID-19 developments – with an upward trajectory in case numbers, new locations, persistent unlinked mystery cases of unknown origin appearing under alert level 3 conditions, and transmission of Delta across the borders – does remain worrying against the backdrop of a population that is still only about 50% fully vaccinated. High vaccination rates of at least 90% and beyond, coupled with the appropriate public health steps against Delta, will help avoid future higher alert level lockdown measures – paramount to keeping everyone safe from COVID-19.

“Caution and compassion will be needed moving forward, as a high degree of risk remains for all in Aotearoa New Zealand, but especially for our most vulnerable communities – and our children.

“The implications for the COVID-19 situation moving forward must include a continued equity focus for approaching vaccination, testing and prevention efforts – this will help reduce barriers, improve access and build trust with vulnerable communities to ensure people get the help they need, when they need it, whether it be the vaccine or a test or other health and support services.

“It is critical that those who are unwell and require hospital or emergency care, still come forward to get the medical care they need.

“Get Vaccinated, to Stay Safe, and Keep Others Around You Safe.”

No conflict of interest declared.

Dr Dougal Sutherland, Clinical Psychologist, Victoria University of Wellington and Umbrella Wellbeing, comments:

“As rules and restrictions around COVID become more complicated so to do our psychological reactions. While the concept of a team of 5 million is useful in bringing us together to defeat Delta, it loses its value when trying to understand varying emotional across the country under Delta.

“Mainlanders may well feel frustration and disappointment about not being able to move around as freely as they would wish. Those in Northland maybe experiencing ongoing anxiety around the potential secret spreading of Delta in their area. Some Aucklanders could experience a sense of resignation and languishing as their restrictions continue. Business owners may be stressed to the max; parents worried about children having to continue learning from home and then about them returning to school.

“As we see a splintering of these emotional responses it can be useful to remember that we don’t know other people’s stories until we’ve asked them. Assuming we all have a shared response at present could lead to further confusion and frustration as others aren’t reacting in the way we think they “should”. The importance of stopping and checking in on our own state of mind, and extending that same patience and understanding to others, has never been stronger.”

No conflict of interest declared.

*This paragraph previously stated that keeping students out of school indefinitely is not a solution. This sentence was deleted on 12/10/21.